Presented February, 2006 in Atlanta, GA
THE CHANGING BLOOD TRANSFUSION PRACTICE IN MINIMALLY INVASIVE ROBOTIC-ASSISTED PROSTATECTOMIES
L Olesnicky, A Jackson, P Galdon, D Savatta, L Galdieri, J Torres and P Tsang.
Department of Pathology and Surgery, Newark Beth Israel Medical Center, Newark, NJ, United States
Background: Robotic prostatectomy is a minimally invasive and sophisticated surgical method for removing the prostate using a robotic device. As far as we know, there have been no published studies comparing blood loss in robotic and non-robotic prostatectomies. In our institution, all elective prostatectomies (robotic and non-robotic) automatically trigger 2 units of typed and crossmatched blood reserved for these patients in anticipation of blood loss, according to the institution s Maximum Surgical Blood Order Schedule (MSBOS).
Design: All radical prostatectomies in our institution from January 2003 to
August 2005 were analyzed for intraoperative blood usage.
Result: Blood loss during the da Vinci (Intuitive Surgical, Inc., Sunnyvale,
CA) robotic assisted prostatectomies was minimal. None of the 31 (0%) robotic
prostatectomies required blood transfusion. On the other hand, each of the 12
traditional open radical prostatectomies performed (100%) required 2 units of
crossmatched blood intraoperatively. One (1) laparoscopic radical prostatectomy
was performed during this period, for which transfusion of 2 units of crossmatched
blood was also required (100%).
Conclusion: Robotic prostatectomy is gaining popularity around the nation as
a less invasive way of removing the prostate for cancer than open surgery. It
allows the surgeon to remotely and precisely control the movements of instruments
positioned inside the patient through small incisions. Our findings indicate
that robotic prostatectomy has the advantage of reducing intraoperative blood
loss (0% transfusion requirement) compared to non-robotic procedures (100% transfusion
requirement). While most blood products are safe and most transfusions are uneventful,
blood transfusions are not entirely risk-free. This study suggests that preoperative
typed and crossmatched blood for robotic prostatectomy may be safely replaced
by a simpler type and screen process in the blood bank. This could represent
an opportunity for improving efficiency in the blood bank by decreasing unnecessary
crossmatching and decreasing wastage of expired blood products. However, additional
blood usage data based on a larger series of robotic prostatectomy would be
necessary to ultimately effect a change in our blood order protocol. Future
studies should also include blood usage in other types of minimally invasive
robotic-assisted surgeries.
Updated Aug 27th, 2006